In plain words
A uterotonic is any medicine or substance that makes the uterus contract. The best-known is , the hormone that also triggers milk . After a birth, a uterotonic is often given right after the baby is born or after the placenta is delivered to lower the chance of heavy bleeding. Other uterotonics are used when bleeding continues. Midwives who attend home births carry them too. A provider can say which one is planned and why. Some uterotonics are not suitable for people with certain conditions, such as high blood pressure, so a mother's history matters.
The deeper version
Uterotonic pharmacology spans oxytocin, a E or F analogue (misoprostol or carboprost), and ergot alkaloids (methylergonovine), each acting on myometrial receptors or calcium signaling. WHO (2012) recommends oxytocin as the first-line uterotonic for prevention of at birth, and ACOG Practice Bulletin 183 (2017) concurs. Ergot derivatives are contraindicated in hypertensive disorders and some cardiovascular conditions because of vasoconstriction. Heat-stable carbetocin is licensed in some countries and studied in trials, including the CHAMPION trial (Widmer et al., NEJM 2018), which found it non-inferior to oxytocin for the combined outcome of blood loss of 500 mL or more or the need for additional uterotonics after vaginal birth. Most controversy concerns third-stage management in low-resource settings and the relative effects of different agents.
Where it comes up
- Heavy bleeding after birth (hemorrhage)Birth and the First Days
- The stages of labor, plainlyBirth and the First Days
- Planning a cesareanGetting Ready for Birth
- Hospital, birth center, or homeGetting Ready for Birth
What mothers here say about uterotonic
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Sources
- World Health Organization — WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage, 2012
- American College of Obstetricians and Gynecologists — Practice Bulletin 183: Postpartum Hemorrhage, 2017
- Widmer M et al. for the CHAMPION trial — Heat-stable carbetocin versus oxytocin to prevent hemorrhage after vaginal birth. New England Journal of Medicine 2018